In the present report, an unusual case of recurrent Miller Fisher syndrome is described. The patient presented within ten years three similar episodes of ophthalmoplegia, ataxia and areflexia associated with oropharyngeal weakness and signs of mild distal sensory neuropathy. An elevated titer of anti-GQ1b ganglioside antibodies correlated well with the clinical symptoms and signs. The pathogenic role of these antibodies in Miller Fisher syndrome is discussed.